Measures of physical functioning are among the strongest predictors of mortality, but no previous study has assessed whether the predictive value of such measures varies by race/ethnicity, as has been done for the simple self-rated health question. The current study tests whether the relationship between two measures of physical functioning (the number of self-reported functional limitations and measured walking speed) and mortality is weaker (has a lower hazard ratio) for Latinos and blacks than for whites. Data were drawn from the 1998–2014 waves of the Health and Retirement Study, with mortality follow-up through 2016. We used Cox hazard models with household random effects to test for interactions between race/ethnicity and these measures of physical functioning and verified earlier findings for self-rated health. The number of self-reported functional limitations is significantly related to mortality for all racial/ethnic groups, but has a substantially lower hazard ratio for blacks and Latinos than for whites, as hypothesized. This hazard ratio remains lower for blacks and Latinos after adjustment for sociodemographic characteristics and health conditions. These findings suggest that the higher rates of functional limitations observed among Latinos and blacks compared with whites may reflect a history of strenuous physical work, inadequately controlled pain, lower leisure-time physical activity, or untreated/under-treated mobility problems that can lead to reduced physical performance without necessarily having a substantial effect on mortality risk. On the other hand, we do not detect significant racial/ethnic differences in the association between measured walking speed and subsequent mortality. This may be the result of the smaller sample size for the walking speed tests, the more nuanced nature of the continuous walking speed measure, or the fact that the walking speed test captures only a subset of the limitations included in the self-reports.
Background: Inequalities in mortality are often attributed to socioeconomic differences in education level, income, and wealth. Low socioeconomic status (SES) is generally related to worse health and survival across the life course. Yet, disadvantaged people are also more likely to hold jobs requiring heavy physical labor, repetitive movement, ergonomic strain, and safety hazards.
Objective: We examine the link between primary lifetime occupation, together with education and net worth, on survival among older adults in Mexico.
Methods: We use data from four waves (2001, 2003, 2012, and 2015) of the Mexican Health and Aging Study (MHAS). We estimate age-specific mortality rates for ages 50 and over using a hazards model based on a two-parameter Gompertz function.
Results: Primary lifetime occupations have a stronger association with survival for women than men. Women with higher socioeconomic status have significantly lower mortality rates than lower status women, whether SES is assessed in terms of schooling, wealth, or occupation. Occupational categories are not jointly related to survival among men, even without controls for education and wealth. There are significant survival differences by wealth among men, but no disparities in mortality by education.
Conclusions: Consistent with recent studies of the Mexican population, we fail to find the expected gradient in the association between some measures of SES and better survival among men.
Contribution: Our estimates extend this anomalous pattern among Mexican men to another dimension of SES, occupation. SES differentials in mortality are substantially larger for Mexican women, highlighting an important gender disparity.
Foreign-born women have heavier infants than US-born women, but it is unclear whether this advantage persists across generations for all races and ethnicities.
Using 1971-2015 Florida birth records, we linked records of female infants within families to assess intergenerational changes in birthweight and prevalence of low birthweight by grandmother’s race, ethnicity and foreign-born status. We also assessed educational gradients in low birthweight in two generations.
Compared to daughters of US-born black women, daughters of foreign-born black women had substantially higher birthweights (3,199 v. 3,083 grams) and lower prevalence of low birthweight (7.8% v. 11.8%). Daughters of foreign-born Hispanic women had moderately higher birthweights (3,322 v. 3,268 grams) and lower prevalence of low birthweight (4.5% v. 6.2%) than daughters of US-born Hispanic women. In the next generation, a Hispanic foreign-origin advantage persisted in low birthweight prevalence (6.1% v. 7.2%), but the corresponding black foreign-origin advantage was almost eliminated (12.2% v. 13.1%). Findings were robust to adjustment for sociodemographic and medical risk factors. In contrast to patterns for other women, the prevalence of low birthweight varied little by maternal education for foreign-born black women. However, a gradient emerged among their US-born daughters.
The convergence of birthweight between descendants of foreign-born and US-born black women is consistent with theories positing that lifetime exposure to discrimination and socioeconomic inequality is associated with adverse health outcomes for black women. The emergence of a distinct educational gradient in low birthweight prevalence between generations underscores hypothesized adverse effects of multiple dimensions of disadvantage.
The Social Environment and Biomarkers of Aging Study (SEBAS) was a joint undertaking between the Taiwan Health Promotion Administration, Ministry of Health and Welfare (formerly the Taiwan Provincial Institute of Family Planning), and Princeton and Georgetown Universities, with notable contributions from others over the life of the project.
The very extensive data that were collected as part of the ongoing Taiwan Longitudinal Study of Aging (TLSA) provided a strong foundation for the underlying research questions: (1) what are the reciprocal relationships among health, the social environment, and exposure to challenge and (2) what can be learned from biomarkers about the pathways and mechanisms through which those relationships operate. The TLSA data – the first round was done in 1989 – comprised self-reported information on demographic characteristics, health and health-related behaviors, occupational and residential histories, participation in social activities, economic and educational status, and emotional and instrumental support (Chang et al. 2008; Taiwan Provincial Institute of Family Planning and Population Studies Center and Institute of Gerontology, University of Michigan 1989). The goal with the SEBAS was to update information from the most recent round of TLSA, to obtain information on exposure to stressors, and to collect measurements and specimens from the TLSA participants that would then be used to obtain biomarkers.
At the time the project began, few psychosocial surveys included the collection of biomarkers; SEBAS might have been the first to do so on a countrywide representative sample (albeit one limited to an older set of participants). As described below, the choice of biomarkers was modeled on the MacArthur Study of Successful Aging (Chang et al. 2008), which used the idea of allostatic load (McEwen and Stellar 1993) to understand how life’s challenges play out at the physiological level.
The initial pretest for SEBAS was performed in 1997–1998 (Weinstein et al. 2003); the first round was fielded in 2000 (Goldman et al. 2003, 2006) and the final round, which as described below collected performance assessments and self-reported information about health status, was completed in 2016.
Although declarative memory declines with age, sex and education might moderate these weaknesses. We investigated effects of sex and education on nonverbal declarative (recognition) memory in 704 older adults (aged 58–98, 0–17 years of education). Items were drawings of real and made-up objects. Age negatively impacted declarative memory, though this age effect was moderated by sex and object-type: it was steeper for males than females, but only for real objects. Education was positively associated with memory, but also interacted with sex and object-type: education benefited women more than men (countering the age effects, especially for women), and remembering real more than made-up objects. The findings suggest that nonverbal memory in older adults is associated negatively with age but positively with education; both effects are modulated by sex, and by whether learning relates to preexisting or new information. The study suggests downstream benefits from education, especially for girls.
Quantification of biological aging is of interest in gerontology as a means to surveil aging rates in the population and to evaluate the effects of interventions to increase healthy life span. Analysis of proposed methods to quantify biological aging has focused on samples of midlife or mixed-age adults in the West. Research is needed to test whether quantifications of biological aging can differentiate aging rates among older adults and if quantifications of biological aging developed in Western samples can differentiate aging rates in non-Western populations. We conducted analysis of Klemera-Doubal method (KDM) Biological Age and homeostatic dysregulation measures of biological aging developed in the U.S. NHANES and tested in a sample of older Taiwanese adults in the Social Environment and Biomarkers of Aging Study. We conducted analysis of physical and cognitive function and mortality, comparing quantifications of biological aging to a biomarker index based on norms within our analysis sample and to participants’ ratings of their own health. Results showed that quantifications of biological aging (a) predicted differences in physical and cognitive function and in mortality risk among Taiwanese older adults and (b) performed as well as a traditional biomarker index and participant self-rated health for prediction of these outcomes.
We demonstrate widening socioeconomic disparities in perceived economic distress among Americans, characterized by increasing distress at the bottom and improved perceptions at the top of the socioeconomic ladder. We then assess the extent to which hardships related to the Great Recession account for the growing social disparity in economic distress. Based on the concept of loss aversion, we also test whether the psychological pain associated with a financial loss is greater than the perceived benefit of an equivalent gain. Analyses are based on longitudinal survey data from the Midlife Development in the US study. Results suggest that widening social disparities in perceived economic distress between the mid-2000s and mid-2010s are explained in part by differential exposure to hardships related to the Great Recession, the effects of which have lingered even four to five years after the recession officially ended. Yet, auxiliary analyses show that the socioeconomic disparities in economic distress widened by nearly as much (if not more) during the period from 1995–96 to 2004–05 as they did during the period in which the recession occurred, which suggests that the factors driving these trends may have already been in motion prior to the recession. Consistent with the loss aversion hypothesis, perceptions of financial strain appear to be somewhat more strongly affected by losses in income/assets than by gains, but the magnitude of the differentials are small and the results are not robust. Our findings paint a dismal portrait of a growing socioeconomic divide in economic distress throughout the period from the mid-1990s to the mid-2010s, although we cannot say whether these trends afflict all regions of the US equally. Spatial analysis of aggregate-level mortality and objective economic indicators could provide indirect evidence, but ultimately economic “despair” must be measured subjectively by asking people how they perceive their financial situations.
Apolipoprotein E (APOE) genotype is believed to play a role in the onset of dementia, though less is known about its relationship with non-pathogenic age-related cognitive decline. We assessed whether APOE was a risk factor for cognitive decline among older Taiwanese adults using nationally representative data. General cognition was measured longitudinally over eleven years; domain-specific cognitive assessments of working memory, declarative learning and three aspects of attention (executive function, alerting, and orientation) were performed once. Having at least one risky APOE allele was associated with more rapid longitudinal cognitive decline compared to those with no risky alleles. Some evidence from the cross-sectional analysis of domain-specific cognitive assessments suggested that APOE genotype may be more closely associated with working memory and declarative learning than with attention. Most genetic studies of cognition include only populations of European descent; extension is crucial. This study confirmed the association between APOE genotype and the rate of cognitive decline in a predominantly Han Chinese population. Additional studies on diverse populations are warranted.
Although there is little dispute about the impact of the US opioid epidemic on recent mortality, there is less consensus about whether trends reflect increasing despair among American adults. The issue is complicated by the absence of established scales or definitions of despair as well as a paucity of studies examining changes in psychological health, especially well-being, since the 1990s. We contribute evidence using two cross-sectional waves of the Midlife in the United States (MIDUS) study to assess changes in measures of psychological distress and well-being. These measures capture negative emotions such as sadness, hopelessness, and worthlessness, and positive emotions such as happiness, fulfillment, and life satisfaction. Most of the measures reveal increasing distress and decreasing well-being across the age span for those of low relative socioeconomic position, in contrast to little decline or modest improvement for persons of high relative position.
We evaluate the variability in estimates of self-reported physical limitations by age across four nationally representative surveys in the US. We consider its implications for determining whether, as previous literature suggests, the US estimates reveal limitations at an earlier age than in three countries with similar life expectancy: England, Taiwan, and Costa Rica. Based on cross-sectional data from seven population-based surveys, we use local mean smoothing to plot self-reported limitations by age for each of four physical tasks for each survey, stratified by sex. We find substantial variation in the estimates in the US across four nationally-representative surveys. For example, one US survey suggests that American women experience a walking limitation 15 years earlier than their Costa Rican counterparts, while another US survey implies that Americans have a 4-year advantage. Differences in mode of survey may account for higher prevalence of limitations in the one survey that used a self-administered mail-in questionnaire than in the other surveys that used in-person or telephone interviews. Yet, even among US surveys that used the same mode, there is still so much variability in estimates that we cannot conclude whether Americans have better or worse function than their counterparts in the other countries. Seemingly minor differences in question wording and response categories may account for the remaining inconsistency. If minor differences in question wording can result in such extensive variation in the estimates within a given population, then lack of comparability is likely to be an even greater problem when examining results across countries that do not share the same language or culture. Despite the potential utility of self-reported physical function within a survey sample, our findings imply that absolute estimates of population-level prevalence of self-reported physical limitations are unlikely to be strictly comparable across countries—or even across surveys within the same population.
The chapter first reviews extant literature on educational gradients in physiological dysregulation. Prior studies suggested there is an inverse relationship between education and risk, although the association may be weaker at the oldest ages and stronger among whites than blacks; the educational gradient may differ by country; and sex differences in the educational gradient may depend on the context. The chapter then presents new comparative analyses of the relationship between physiological dysregulation and education based on data from five countries (United States, England, Russia, Costa Rica, and Taiwan). Large educational differences were found in dysregulation in Russia, US white men, US black women, and English white women. The finding that the educational differential among US women is larger for blacks than for whites appears to be sensitive to how one defines “high” education. Using race-specific cutoffs, the education gradient did not differ significantly between black and white women.
There is no doubt that economic inequality in the US has increased over the last several decades (Piketty, Saez, and Zucm 2016; Congressional Budget Office 2013). Diminished labor market opportunities and the ensuing decline in (inflation‐adjusted) economic fortunes for the least educated Americans have been blamed for initiating a cascade of consequences culminating in rising mortality related to drugs, alcohol, and suicide (Case and Deaton 2017; 2015)—collectively referred to as “deaths of despair” (Khazan 2015; Case 2015; Monnat 2016). The health effects are evident in overall mortality as well: socioeconomic disparities in life expectancy have widened dramatically over this period (Chetty et al. 2016b; Bosworth, Burtless, and Zhang 2016), particularly among non‐Latino whites (Olshansky et al. 2012; Sasson 2016). Beyond its effects on health, inequality1 can have far‐reaching consequences for society as a whole, for example, by compromising social trust and cohesion and jeopardizing the effectiveness of social institutions (Kawachi and Berkman 2000; Kawachi et al. 1997). Indeed, arguments related to growing inequality have been invoked to explain many of the worrisome trends not only in mortality, but in a broader range of health outcomes, as well as social and political phenomena.
Working memory (WM), which underlies the temporary storage and manipulation of information, is critical for multiple aspects of cognition and everyday life. Nevertheless, research examining WM specifically in older adults remains limited, despite the global rapid increase in human life expectancy. We examined WM in a large sample (N=754) of healthy older adults (aged 58-89) in a non-Western population (Chinese speakers) in Taiwan, on a digit n-back task. We tested the influence not only of age itself and of load (1-back vs. 2-back), but also effects of both sex and education, which have been shown to modulate WM abilities. Mixed-effects regression revealed that, within older adulthood, age negatively impacted WM abilities (with linear, not nonlinear, effects), as did load (worse performance at 2-back). In contrast, education level was positively associated with WM. Moreover, both age and education interacted with sex. With increasing age, males showed a steeper WM decline than females; with increasing education, females showed greater WM gains than males. Together with other findings, the evidence suggests that age, sex, and education all impact WM in older adults, but interact in particular ways. The results have both basic research and translational implications, and are consistent with particular benefits from increased education for women.
The increased risk for poor physical and mental health outcomes for older parents in Mexico who have an adult child living in the United States may contribute to an increased risk for cognitive impairment in this population. The objective of this study was to examine if older adults in Mexico who have one or more adult children living in the United States are more or less likely to develop cognitive impairment over an 11-year period compared to older adults who do not have any adult children living in the United States.
The hypothesis that the S allele of the 5-HTTLPR serotonin transporter promoter region is associated with increased risk of depression, but only in individuals exposed to stressful situations, has generated much interest, research and controversy since first proposed in 2003. Multiple meta-analyses combining results from heterogeneous analyses have not settled the issue. To determine the magnitude of the interaction and the conditions under which it might be observed, we performed new analyses on 31 data sets containing 38 802 European ancestry subjects genotyped for 5-HTTLPR and assessed for depression and childhood maltreatment or other stressful life events, and meta-analysed the results. Analyses targeted two stressors (narrow, broad) and two depression outcomes (current, lifetime). All groups that published on this topic prior to the initiation of our study and met the assessment and sample size criteria were invited to participate. Additional groups, identified by consortium members or self-identified in response to our protocol (published prior to the start of analysis) with qualifying unpublished data, were also invited to participate. A uniform data analysis script implementing the protocol was executed by each of the consortium members. Our findings do not support the interaction hypothesis. We found no subgroups or variable definitions for which an interaction between stress and 5-HTTLPR genotype was statistically significant. In contrast, our findings for the main effects of life stressors (strong risk factor) and 5-HTTLPR genotype (no impact on risk) are strikingly consistent across our contributing studies, the original study reporting the interaction and subsequent meta-analyses. Our conclusion is that if an interaction exists in which the S allele of 5-HTTLPR increases risk of depression only in stressed individuals, then it is not broadly generalisable, but must be of modest effect size and only observable in limited situations.
We compare physical performance from three U.S. national surveys and nationally representative surveys in England, Taiwan, and Costa Rica. Method: For each performance test, we use local mean smoothing to plot the age profiles by sex and survey wave and then fit a linear regression model to the pooled data, separately by sex, to test for significant differences across surveys controlling for age and height. Results: Age profiles of performance vary across U.S. surveys, but levels of lung function (peak expiratory flow) and handgrip strength in the United States are as high as they are in the other three countries. Americans also perform as well on the chair stand test as the English and Costa Ricans, if not better, but exhibit slower gait speed than the English at most ages. Discussion: With the exception of walking speed, we find little evidence that older Americans have worse physical performance than their peers.
Using five waves of the Taiwanese Longitudinal Study of Aging (1996–2011), we investigate (1) the association between family members’ education and the age trajectories of individuals’ depressive symptoms and (2) gender differences in those relationships. Our examination is guided by several theoretical frameworks, including social capital, social control, age as leveler, and resource substitution. Nested models show that having a more educated father is associated with lower depressive symptoms, but the relationship disappears after controlling for respondent’s education. Including spouse’s education attenuates the coefficient for respondent’s education. A similar pattern appears when children’s education is added to the model. Among all the family members, children’s education has the strongest association with depressive symptoms, with a similar magnitude for both genders, although its strength gradually weakens as respondents age. Our findings suggest the importance of the transfer of resources from children to parents and how it may affect mental health at older ages.
We consider a broad set of variables used by social scientists and clinicians to identify the leading predictors of five‐year survival among American adults. We address a question not considered in earlier research: Do the strongest predictors of survival vary by age, sex or race/ethnicity? The analysis uses hazard models with 30 well‐established predictors to examine five‐year survival in the National Health and Nutrition Examination Survey. We find that the simple measure of self‐assessed health and self‐reported measures of functional ability and disability are the strongest predictors in all demographic groups, and are generally ranked considerably higher than biomarkers. Among the biomarkers, serum albumin is highly ranked in most demographic groups, whereas clinical measures of cardiovascular and metabolic function are consistently among the weakest predictors. Despite these similarities, there is substantial variation in the leading predictors across demographic groups, most notably by race and ethnicity
Social inequalities in health and disability are often attributed to differences in childhood adversity, access to care, health behavior, residential environments, stress, and the psychosocial aspects of work environments. Yet, disadvantaged people are also more likely to hold jobs requiring heavy physical labor, repetitive movement, ergonomic strain, and safety hazards. We investigate the role of physical work conditions in contributing to social inequality in mobility among older adults in Mexico, using data from the Mexican Health and Aging Survey (MHAS) and an innovative statistical modeling approach. We use data on categories of primary adult occupation to serve as proxies for jobs with more or less demanding physical work requirements. Our results show that more physically demanding jobs are associated with mobility limitations at older ages, even when we control for age and sex. Inclusion of job categories attenuates the effects of education and wealth on mobility limitations, suggesting that physical work conditions account for at least part of the socioeconomic differentials in mobility limitations in Mexico.
Researchers often rely on respondents' self-rated health (SRH) to measure social disparities in health, but recent studies suggest that systematically different reporting styles across groups can yield misleading conclusions about disparities in SRH. In this study, we test whether this finding extends to ethnic differences in self-assessments of health in particular domains. We document differences between US-born whites and four Latino subgroups in respondents' assessments of health in six health domains using data from the second wave of the Los Angeles Family and Neighborhood Survey (N = 1468). We use both conventional methods and an approach that uses vignettes to adjust for differential reporting styles.
The Social Environment and Biomarkers of Aging Study (SEBAS) is a nationally representative longitudinal survey of Taiwanese middle-aged and older adults. It adds the collection of biomarkers and performance assessments to the Taiwan Longitudinal Study of Aging (TLSA), a nationally representative study of adults aged 60 and over, including the institutionalized population. The TLSA began in 1989, with follow-ups approximately every 3 years; younger refresher cohorts were added in 1996 and 2003. The first wave of SEBAS, based on a sub-sample of respondents from the 1999 TLSA, was conducted in 2000. A total of 1023 respondents completed both a face-to-face home interview and, several weeks later, a hospital-based physical examination. In addition to a 12-h (7 pm–7 am) urine specimen collected the night before and a fasting blood specimen collected during the examination, trained staff measured blood pressure, height, weight and waist and hip circumferences. A second wave of SEBAS was conducted in 2006 using a similar protocol to SEBAS 2000, but with the addition of performance assessments conducted by the interviewers at the end of the home interview. Both waves of SEBAS also included measures of health status (physical, emotional, cognitive), health behaviours, social relationships and exposure to stressors. The SEBAS data, which are publicly available at [ http://www.icpsr.umich.edu/icpsrweb/NACDA/studies/3792/version/5 ], allow researchers to explore the relationships among life challenges, the social environment and health and to examine the antecedents, correlates and consequences of change in biological measures and health.
This study examines whether frailty is associated with mortality independently of physiological dysregulation (PD) and, if so, which is the more accurate predictor of survival. Data come from the Social Environment and Biomarkers of Aging Study. We use Cox proportional hazard models to test the associations between PD, frailty, and 4- to 5-year survival. We use Harrell’s concordance index to compare predictive accuracy of the models. Both PD and frailty are significantly, positively, and independently correlated with mortality: Worse PD scores and being frail are associated with a higher risk of dying. The overall PD score is a more accurate predictor of survival than frailty, although model prediction improves when both measures are included. PD and frailty independently predict mortality, suggesting that the two measures may be capturing different aspects of the same construct and that both may be important for identifying individuals at risk for adverse health outcomes
Persons of Mexican origin and some other Latino groups in the United States have experienced a survival advantage compared with their non-Latino White counterparts, a pattern known as the Latino, Hispanic, or epidemiological paradox. However, high rates of obesity and diabetes among Latinos relative to Whites and continued increases in the prevalence of these conditions suggest that this advantage may soon disappear. Other phenomena, including high rates of disability in the older Latino population compared with Whites, new evidence of health declines shortly after migration to the United States, increasing environmental stressors for immigrants, and high-risk values of inflammatory markers among Latinos compared with Whites support this prediction. One powerful counterargument, however, is substantially lower smoking-attributable mortality among Latinos. Still, it is questionable as to whether smoking behavior can counteract the many forces at play that may impede Latinos from experiencing future improvements in longevity on a par with Whites.
Telomere length has generated substantial interest as a potential predictor of aging-related diseases and mortality. Some studies have reported significant associations, but few have tested its ability to discriminate between decedents and survivors compared with a broad range of well-established predictors that include both biomarkers and commonly collected self-reported data. Our aim here was to quantify the prognostic value of leukocyte telomere length relative to age, sex, and 19 other variables for predicting five-year mortality among older persons in three countries. We used data from nationally representative surveys in Costa Rica (N = 923, aged 61+), Taiwan (N = 976, aged 54+), and the U.S. (N = 2672, aged 60+). Our study used a prospective cohort design with all-cause mortality during five years post-exam as the outcome. We fit Cox hazards models separately by country, and assessed the discriminatory ability of each predictor. Age was, by far, the single best predictor of all-cause mortality, whereas leukocyte telomere length was only somewhat better than random chance in terms of discriminating between decedents and survivors. After adjustment for age and sex, telomere length ranked between 15th and 17th (out of 20), and its incremental contribution was small; nine self-reported variables (e.g., mobility, global self-assessed health status, limitations with activities of daily living, smoking status), a cognitive assessment, and three biological markers (C-reactive protein, serum creatinine, and glycosylated hemoglobin) were more powerful predictors of mortality in all three countries. Results were similar for cause-specific models (i.e., mortality from cardiovascular disease, cancer, and all other causes combined). Leukocyte telomere length had a statistically discernible, but weak, association with mortality, but it did not predict survival as well as age or many other self-reported variables. Although telomere length may eventually help scientists understand aging, more powerful and more easily obtained tools are available for predicting survival.
There are large socioeconomic disparities in adult mortality in Russia, although the biological mechanisms are not well understood. With data from the study of Stress, Aging, and Health in Russia (SAHR), we use Gompertz hazard models to assess the relationship between educational attainment and mortality among older adults in Moscow and to evaluate biomarkers associated with inflammation, neuroendocrine function, heart rate variability, and clinical cardiovascular and metabolic risk as potential mediators of that relationship. We do this by assessing the extent to which the addition of biomarker variables into hazard models of mortality attenuates the association between educational attainment and mortality. We find that an additional year of education is associated with about 5% lower risk of age-specific all-cause and cardiovascular mortality. Inflammation biomarkers are best able to account for this relationship, explaining 25% of the education-all-cause mortality association, and 35% of the education-cardiovascular mortality association. Clinical markers perform next best, accounting for 13% and 23% of the relationship between education and all-cause and cardiovascular mortality, respectively. Although heart rate biomarkers are strongly associated with subsequent mortality, they explain very little of the education-mortality link. Neuroendocrine biomarkers fail to account for any portion of the link. These findings suggest that inflammation may be important for understanding mortality disparities by socioeconomic status.
Despite myriad efforts among social scientists, epidemiologists, and clinicians to identify variables with strong linkages to mortality, few researchers have evaluated statistically the relative strength of a comprehensive set of predictors of survival. Here, we determine the strongest predictors of five-year mortality in four national, prospective studies of older adults. We analyze nationally representative surveys of older adults in four countries with similar levels of life expectancy: England (n = 6113, ages 52+), the US (n = 2023, ages 50+), Costa Rica (n = 2694, ages 60+), and Taiwan (n = 1032, ages 53+). Each survey includes a broad set of demographic, social, health, and biological variables that have been shown previously to predict mortality. We rank 57 predictors, 25 of which are available in all four countries, net of age and sex. We use the area under the receiver operating characteristic curve and assess robustness with additional discrimination measures. We demonstrate consistent findings across four countries with different cultural traditions, levels of economic development, and epidemiological transitions. Self-reported measures of instrumental activities of daily living limitations, mobility limitations, and overall self-assessed health are among the top predictors in all four samples. C-reactive protein, additional inflammatory markers, homocysteine, serum albumin, three performance assessments (gait speed, grip strength, and chair stands), and exercise frequency also discriminate well between decedents and survivors when these measures are available. We identify several promising candidates that could improve mortality prediction for both population-based and clinical populations. Better prognostic tools are likely to provide researchers with new insights into the behavioral and biological pathways that underlie social stratification in health and may allow physicians to have more informed discussions with patients about end-of-life treatment and priorities.
Models of stress incorporate both the environmental demands experienced by individuals (stressors) and the appraisal of these life events (perceptions). Because little is known about the extent to which experience and perceptions are related, we examine this relationship in a nationally representative population of older Taiwanese adults.
Using growth models applied to data from 3 waves (1999, 2003, and 2007) of the Taiwan Longitudinal Study of Aging, we (a) investigate patterns of change in perceived stress in later adulthood and (b) examine how experienced stressors influence perceived stress. Participants were asked to report the presence of, and in some cases the degree of, exposure to stressors including total number of medical conditions, difficulty with activities of daily living, difficulty with mobility functions, being financially worse off compared with the prior wave, experiencing the death of a child, and experiencing a marital disruption. Items reflecting perceived stress included concerns about various domains pertaining to the respondent and his/her family member.
Our results indicate that exposure to stressors increases, whereas perceived stress decreases, over time. Change in exposure to stressors is not generally associated with change in perceptions of stress, with the exception of a summary measure of health-related exposure to stressors. An increase in poor health over time is related to an increase in perceived stress in all domains.
Objective: The study documents whether socioeconomic status (SES) differentials in biological risk are more widely observed and larger in the United States than Taiwan. Method: Data come from the Social Environment and Biomarkers of Aging Study in Taiwan and the Midlife in the United States study. We use regression analyses to test whether four summary measures of biological risk are significantly related to categorical measures of education, income, and subjective social status among four country–sex-specific subgroups. Results: Physiological dysregulation is significantly, negatively related to SES in both the United States and Taiwan, especially for males. The prevalence and magnitude of the relationships are similar in the two countries: 12 of 24 possible SES–biological summary score relationships are significant in the United States and 11 of 24 are significant in Taiwan. Discussion: Overall, SES differentials in biological risk do not appear to be more widely observed or larger in the United States than in Taiwan.
Recent studies have found mixed results regarding the association between leukocyte telomere length (LTL)—thought to be a marker of cellular aging—and all-cause mortality. Some studies have reported a significant inverse relationship, but others have not, perhaps in part owing to insufficient power. We examine the relationship using data from a nationally representative sample of older Taiwanese (54+ in 2000), which is larger ( n = 942) than most previous studies, and which includes comprehensive information on potential confounders including white blood cell distribution and inflammatory markers. Results from a Cox hazards model demonstrate a small, but significant, association between LTL and mortality that is independent of age, sex, and lifestyle factors. White blood cell distribution, especially the proportion of neutrophils, is an important predictor of LTL; however, the association between LTL and mortality changes little controlling for white blood cell distribution. In contrast, the association between LTL and mortality weakens considerably (by 48%) after adjustment for inflammatory markers and homocysteine. Our results suggest that the relationship between short telomeres and mortality is tied to inflammation and homocysteine. Longitudinal studies are needed to explore bidirectional influences resulting from the fact that inflammation leads to shorter leukocyte telomeres, which in turn results in senescence, which exacerbates inflammation.
Differentials in mortality by socioeconomic status and the nature of social relationships have been well established in a broad range of settings and time periods. A myriad of studies has investigated the many potential causal pathways linking these aspects of the social environment to health and mortality, with a current emphasis on psychosocial factors, neighborhood contexts, and biological linkages. Recent efforts have exploited longitudinal surveys, some beginning at birth, to strengthen causal inferences. Fewer researchers have focused on identifying selection mechanisms or reverse causal pathways through which, for example, poor health may lead to reduced income or exclusion from marriage.
We use data from three rounds of the Mexican Family Life Survey to examine whether migrants in the United States returning to Mexico in the period 2005–2012 have worse health than those remaining in the United States. Despite extensive interest by demographers in health-related selection, this has been a neglected area of study in the literature on U.S.-Mexico migration, and the few results to date have been contradictory and inconclusive. Using five self-reported health variables collected while migrants resided in the United States and subsequent migration history, we find direct evidence of higher probabilities of return migration for Mexican migrants in poor health as well as lower probabilities of return for migrants with improving health. These findings are robust to the inclusion of potential confounders reflecting the migrants’ demographic characteristics, economic situation, family ties, and origin and destination characteristics. We anticipate that in the coming decade, health may become an even more salient issue in migrants’ decisions about returning to Mexico, given the recent expansion in access to health insurance in Mexico.
In light of widespread interest in the prognostic value of biomarkers, we apply three discrimination measures to evaluate the incremental value of biomarkers—beyond self-reported measures—for predicting all-cause mortality. We assess whether all three measures—area under the receiver-operating characteristic curve, continuous net reclassification improvement, and integrated discrimination improvement—lead to the same conclusions.
Although many studies have attempted to examine the consequences of Mexico-U.S. migration for Mexican immigrants’ health, few have had adequate data to generate the appropriate comparisons. In this article, we use data from two waves of the Mexican Family Life Survey (MxFLS) to compare the health of current migrants from Mexico with those of earlier migrants and nonmigrants. Because the longitudinal data permit us to examine short-term changes in health status subsequent to the baseline survey for current migrants and for Mexican residents, as well as to control for the potential health selectivity of migrants, the results provide a clearer picture of the consequences of immigration for Mexican migrant health than have previous studies. Our findings demonstrate that current migrants are more likely to experience recent changes in health status—both improvements and declines—than either earlier migrants or nonmigrants. The net effect, however, is a decline in health for current migrants: compared with never migrants, the health of current migrants is much more likely to have declined in the year or two since migration and not significantly more likely to have improved. Thus, it appears that the migration process itself and/or the experiences of the immediate post-migration period detrimentally affect Mexican immigrants’ health.
The death of a child is one of the most traumatic events that a parent can experience. The psychological and physical consequences of bereavement are well established, and the consequences are more severe for mothers than fathers. However, little is known about how the death of an adult child affects parental wellbeing in old age or how the deceased child's sex may moderate the association. We use data from the Taiwanese Longitudinal Study of Aging (TLSA) to investigate how the death of a son or a daughter differentially affects the wellbeing of older parents, measured by depressive symptoms and self-rated health. We find that for mothers, a son's death is associated with an increase in depressive symptoms and a decline in self-rated health, but fathers' health is not adversely affected by a son's death. There is little evidence that a daughter's death has a negative effect on either maternal or paternal wellbeing. We situate these findings within their social and cultural contexts and discuss social policies that would reduce gender and health inequality.
BACKGROUND Although previous studies have indicated that performance assessments strongly predict future survival, few have evaluated the incremental value in the presence of controls for self-reported activity and mobility limitations. OBJECTIVE We assess and compare the added value of four tests walking speed, chair stands, grip strength, and peak expiratory flow (PEF) for predicting all-cause mortality. METHODS Using population-based samples of older adults in Costa Rica (n = 2290, aged 60+) and Taiwan (n = 1219, aged 53+), we estimate proportional hazards models of mortality for an approximate five-year period. Receiver Operator Characteristic (ROC) curves are used to assess the prognostic value of each performance assessment.
Objective: The death or illness of a spouse negatively affects a partner’s health, but little is known about the effect on blood glucose (glycemic) levels. This study investigates the extent to which a spouse’s declining health or death is associated with changes in the glycemic levels of older adults. Method: Data come from a nationally representative longitudinal sample of 597 Taiwanese (aged 54 to 90). We use changes in spousal health and death of a spouse to predict changes in glycosylated hemoglobin (HbA1c) levels over a 6-year period. Results: A decline in spousal health is associated with increased HbA1c levels for women, but not for men. The death of a healthy spouse is associated with increased HbA1c levels for both genders. Discussion:Stressful life transitions may compromise the glycemic levels of older adults. Taking on a caregiving role may erode some of the benefits of marriage and interfere with women’s maintenance of their own health.
The proliferation of biosocial surveys has increased the importance of weighing the costs and benefits of adding biomarker collection to population‐based surveys. A crucial question is whether biomarkers offer incremental value beyond self‐reported measures, which are easier to collect and impose less respondent burden. We use longitudinal data from a nationally representative sample of older Taiwanese (aged 54+ in 2000, examined in 2000 and 2006 with mortality follow‐up through 2011) to address that question with respect to predicting all‐cause mortality. A summary measure of biomarkers improves mortality prediction (as measured by the area under the receiver operating characteristic curve) compared with self‐reports alone, but individual biomarkers perform better than the summary score. We find that incorporating change in biomarkers over a six‐year period yields a small improvement in mortality prediction compared with one‐time measurement. But, is the incremental value worth the costs?
The Russian population continues to face political and economic challenges, has experienced poor general health and high mortality for decades, and has exhibited widening health disparities. The physiological factors underlying links between health and socioeconomic position in the Russian population are therefore an important topic to investigate. We used data from a population-based survey of Moscow residents aged 55 and older (n = 1495), fielded between December 2006 and June 2009, to address two questions. First, are social disparities evident across different clusters of biomarkers? Second, does biological risk mediate the link between socioeconomic status and health?
Obesity among the Mexican-origin adult population in the US has been associated with longer stays in the US and with being US- vs. Mexican-born, two proxies for acculturation. This pattern is less clear for Mexican-origin children and young adults: recent evidence suggests that it may be reversed, with foreign-born Mexican youth in the US at higher risk of obesity than their US-born Mexican–American counterparts. The objective of this study is to evaluate the hypothesis that the immigrant advantage in obesity prevalence for Mexican-origin populations in the US does not hold for children and young adults. We use data from the Los Angeles Family and Neighborhood Survey (N = 1143) and the California Health Interview Survey (N = 25,487) for respondents ages 4–24 to calculate the odds of overweight/obesity by ethnicity and nativity. We find support for the hypothesis that overweight/obesity prevalence is not significantly lower for first-generation compared to second- and third-generation Mexican-origin youth. Significantly higher obesity prevalence among the first generation was observed for young adult males (ages 18–24) and adolescent females (ages 12–17). The previously-observed protective effect against obesity risk among recent adult immigrants does not hold for Mexican-origin youth.
The allostatic load framework implies that cumulative exposure to stressors results in multi-system physiological dysregulation.
The purpose of this study was to investigate the effect of stress burden on subsequent changes (2000–2006) in physiological dysregulation.
Data came from a population-based cohort study in Taiwan (n = 521, aged 54+ in 2000, re-examined in 2006). Measures of stressful events and chronic strain were based on questions asked in 1996, 1999, and 2000. A measure of trauma was based on exposure to the 1999 earthquake. Dysregulation was based on 17 biomarkers (e.g., metabolic, inflammatory, neuroendocrine).
There were some small effects among men: chronic strain was associated with subsequent increases in dysregulation (standardized β = 0.08, 95 % CI = 0.01 to 0.20), particularly inflammation; life events were also associated with increased inflammation (β = 0.10, CI = 0.01 to 0.26). There were no significant effects in women.
Allostatic load theory implies a relationship between exposure to psychological stress and multi-system physiological dysregulation. We used data from population-based samples of men and women in Russia (Moscow; n ¼ 1800; age, mean 68.6 years), Taiwan (n ¼ 1036; 65.6 years) and the United States (US; n ¼ 1054; 58.0 years) – which are likely to vary widely with respect to levels of stress exposure and biological markers – to determine the magnitude of the association between perceived stress and physiological dysregulation. The measure of overall dysregulation was based on 15 markers including standard cardiovascular/metabolic risk factors as well as markers of inflammation and neuroendocrine activity. Subjective psychological stress was measured by the perceived stress scale. Only the Moscow sample demonstrated a positive association with overall dysregulation in both sexes. In the US, we found an association among women but not men. Among the Taiwanese, who report the lowest perceived stress, there was no association in women but an unexpected inverse relationship in men. The effects also varied across system-level subscores: the association with perceived stress was most consistent for standard cardiovascular/metabolic factors. Perceived stress was associated with inflammation and neuroendocrine activity in some samples. Although the evidence that perceived stress is the primary source of physiological dysregulation is generally modest, it was stronger in Russia where the level of perceived stress was particularly high. For Russia only, we had information about heart function based on a 24 h ambulatory electrocardiogram; perceived stress was consistently associated with heart rate dysregulation in Russian men and women.
Objectives: We assessed female–male differences in depressive symptoms among older Taiwanese and quantified the contribution of sex differences in exposure and response to selected covariates in explaining the gap.
Methods: Using data from six survey waves over 18 years for a nationally representative cohort of 4049 Taiwanese aged 60+, we employed growth curve analysis to model individual-level trajectories of depressive symptoms across age.
Results: Among older Taiwanese, women's disadvantage with respect to social position and employment accounted for about 40% of the sex difference in depressive symptoms. Sex differences in decision control and exposure to widowhood and financial decline played surprisingly little role. Although we found no evidence that the effects of marriage, recent widowhood or recent child death varied by sex, living apart from one's children appeared to be more detrimental for women than for men in this society. Moreover, the effect of living with children depended on the arrangement: living with an unmarried son was more strongly associated with depressive symptoms than living with a married son and daughter-in-law.
Conclusion: Sex differentials in social position and employment are major contributors to the sex difference in depressive symptoms among older Taiwanese, yet sex differences in exposure or response to selected stressors appear to play little role. Differential vulnerabilities to particular living arrangements may also contribute to women's excess psychological distress, although more research is needed to elucidate the mechanisms by which living arrangements influence depressive symptoms in Taiwan.
Understanding the metabolic processes associated with aging is key to developing effective management and treatment strategies for age-related diseases. We investigated the metabolic profiles associated with age in a Taiwanese and an American population. 1H NMR spectral profiles were generated for urine specimens collected from the Taiwanese Social Environment and Biomarkers of Aging Study (SEBAS; n = 857; age 54–91 years) and the Mid-Life in the USA study (MIDUS II; n = 1148; age 35–86 years). Multivariate and univariate linear projection methods revealed some common age-related characteristics in urinary metabolite profiles in the American and Taiwanese populations, as well as some distinctive features. In both cases, two metabolites—4-cresyl sulfate (4CS) and phenylacetylglutamine (PAG)—were positively associated with age. In addition, creatine and β-hydroxy-β-methylbutyrate (HMB) were negatively correlated with age in both populations (p < 4 × 10–6). These age-associated gradients in creatine and HMB reflect decreasing muscle mass with age. The systematic increase in PAG and 4CS was confirmed using ultraperformance liquid chromatography–mass spectrometry (UPLC–MS). Both are products of concerted microbial–mammalian host cometabolism and indicate an age-related association with the balance of host–microbiome metabolism.
In recent decades there has been an increasing interest in understanding the role of social and physical contexts in influencing health behaviors and outcomes. This is especially true for weight, which is considered to be highly dependent on environmental factors. The evidence linking neighborhood characteristics to weight in the United States, however, is mixed. Many studies in this area are hampered by cross sectional designs and a limited scope, insofar as they investigate only one dimension of neighborhood context. It is also unclear to what extent neighborhood characteristics account for racial/ethnic disparities in weight. Using longitudinal data from the Los Angeles Family and Neighborhood Survey (L.A. FANS), we compare patterns of weight change between Hispanics and other racial and ethnic groups in order to evaluate whether we observe a pattern of unhealthy assimilation in weight among Hispanic immigrants and to identify differences in the rate at which different groups gain weight over time. We also explore the extent to which patterns of weight change are related to a wider range of community characteristics. We find that weight increases across all groups between the two study waves of L.A. FANS and that the increases are significant except for Asians/Pacific Islanders. With respect to differences in the pace of weight change, second and higher generation Hispanic women and black men gain weight more rapidly than their first generation Hispanic counterparts. Although the evidence presented indicates that first generation Hispanics gain weight, we do not find evidence for convergence in weight since the U.S.-born gain weight at a more rapid rate. The inclusion of community-level variables does not alter the relationships between the race, ethnicity, and immigrant generation categories and weight change. Of the six types of community characteristics considered, only collective efficacy is consistently and significantly associated with weight change, although the protective effect of neighborhood collective efficacy is seen only among women.
Background: Previous studies assessing the validity of adolescent self-reported height and weight for estimating obesity prevalence have not accounted for, potential bias due to nonresponse in self-reports.
Objectives: The aim of this study was to assess the implications of selective nonresponse in self-reports of height and weight for estimates of adolescent obesity.
Methods: The authors analyzed 613 adolescents ages 12–17 years from the 2006–2008 Los Angeles Family and Neighborhood Survey, a longitudinal study of Los Angeles County households with an oversample of poor neighborhoods. Obesity prevalence estimates were compared based on (a) self-report, (b) measured height and weight for those who did report, and (c) measured height and weight for those who did report.
Results: Among younger teens, measured obesity prevalence was higher for those who did not report height and weight compared with those who did (40% vs. 30%). Consequently, obesity prevalence based on self-reported height and weight underestimated measured prevalence by 12 percentage points (when accounting for nonresponse) versus 9 percentage points (when nonresponse was not accounted for). Results were robust to the choice of difference child growth references.
Discussion: Adolescent obesity surveillance and prevention efforts must take into account selective nonresponse for self-reported height and weight, particularly for younger teens. Results should be replicated in a nationally representative sample.
The apolipoprotein E (ApoE) gene, which has three common alleles (ϵ2, ϵ3, and ϵ4), has been linked to a number of health outcomes and longevity. The ϵ2 allele has been reported to have neuroprotective effects, whereas the ϵ4 allele has been shown to be a risk factor for cardiovascular disease and Alzheimer's disease in various populations. The relationships between ApoE and mortality and ApoE and physical function, however, are not clear-cut. We used the Social Environment and Biomarkers of Aging Study (SEBAS) to examine the relationship between ApoE polymorphisms and physical and pulmonary function in approximately 1,000 Taiwanese adults aged 53 years and older in 2006. In the 2006 SEBAS wave, measures of physical function included self-reported difficulties with respect to activities of daily living (ADLs) and other physical function indicators, as well as performance-based measures of grip strength (kg), walking speed (m/s) over a distance of 3 m, and chair stand speed (stand/s). Peak expiratory flow (PEF; L/min) rate was also examined as an indicator of pulmonary function. We used logistic regression models to determine the association between ApoE and inability to complete each of the tests of physical and pulmonary function. These models revealed no significant association between ApoE carrier status and any of the indicators of function. Among participants able to complete a given task, we next used linear regression models to examine self-reported limitations with ADLs and performance on the given test by ApoE carrier status. Similarly, there were no significant relationships between ApoE carrier status and the measures of function. Our estimates provide further confirmation that the ApoE gene may not be a risk factor for functional decline among older Taiwanese adults.
Despite the serious biases that characterize self-rated health, researchers rely heavily on these ratings to predict mortality. Using newly collected survey data, we examine whether simple ratings of participants' health provided by interviewers and physicians can markedly improve mortality prediction.
We use data from a prospective cohort study based on a nationally representative sample of older adults in Taiwan. We estimate proportional-hazard models of all-cause mortality between the 2006 interview and 30 June 2011 (mean 4.7 years' follow-up).
Interviewer ratings were more strongly associated with mortality than physician or self-ratings, even after controlling for a wide range of covariates. Neither respondent nor physician ratings substantially improve mortality prediction in models that include interviewer ratings. The predictive power of interviewer ratings likely arises in part from interviewers' incorporation of information about the respondents' physical and mental health into their assessments.
The findings of this study support the routine inclusion of a simple question at the end of face-to-face interviews, comparable to self-rated health, asking interviewers to provide an assessment of respondents' overall health. The costs of such an undertaking are minimal and the potential gains substantial for demographic and health researchers. Future work should explore the strength of the link between interviewer ratings and mortality in other countries and in surveys that collect less detailed information on respondent health, functioning, and well-being.
Perceived stress is associated with poor health outcomes including negative affect, increased susceptibility to the common cold and cardiovascular disease; the consequences of perceived stress for mortality, however, have received less attention. This study characterizes the relationship between perceived stress and 11-year mortality in a population of Taiwanese adults aged 53+ years. Using the Survey of Health and Living Status of the Near Elderly and Elderly of Taiwan, we calculated a composite measure of perceived stress based on six items pertaining to the health, financial situation, and occupation of the respondents and their families. Proportional hazard models were used to determine whether perceived stress predicted mortality. After adjusting for sociodemographic factors only, we found that a one standard deviation increase in perceived stress was associated with a 19% increase in all-cause mortality risk during the 11-year follow-up period (hazard ratio, HR = 1.19, 95% confidence interval, CI 1.13–1.26). The relationship was greatly attenuated when perceptions of stress regarding health were excluded, and was not significant after adjusting for medical conditions, mobility limitations and depressive symptoms. We conclude that the association between perceived stress and mortality is explained by an individual’s current health; however, our data do not allow us to distinguish between two possible interpretations of this conclusion: (a) the relationship between perceived stress and mortality is spurious, or (b) poor health acts as the mediator.
Exceptions are interesting: They make us ask “why?” Why is this case different? From a scientific perspective—at least in principle—we start with a theory or empirical generalization, and seek to reject it; too often, however, as researchers we seek evidence to confirm our hypotheses. It's only when we find enough exceptions that we feel compelled to reject the rule or significantly amend it. Kahneman (2011, p. 81), as always, makes the point regarding “a deliberate search for confirming evidence, known as positive test strategy,” with elegance and parsimony: “Contrary to the rules of philosophers of science, who advise testing hypotheses by trying to disprove them, people (and scientists, quite often) seek data that are likely to be compatible with the beliefs they currently hold.”
Background Although sons are thought to impose greater physiological costs on mothers than daughters, sons may be advantageous for parental survival in some social contexts. The authors examined the relationship between the sex composition of offspring and parental survival in contemporary China and Taiwan. Because of the importance of sons for the provision of support to elderly parents in these populations, the authors hypothesised that sons would have a beneficial effect on parental survival relative to daughters.
Methods The authors used data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) and the Taiwan Longitudinal Study of Aging (TLSA). The CLHLS sample consisted of 4132 individuals aged 65 years and over in 2002. The TLSA sample comprised two cohorts: 3409 persons aged 60 years and over in 1989 and 2193 persons aged 50–66 years in 1996. These cohorts were followed up for 3, 18 and 11 years, respectively. The Cox proportional hazards model was used to estimate the relationship between the sex composition of offspring and parental mortality.
Results Based on seven measures of sex composition, no protective effect of sons was found in either China or Taiwan. For example, in the 1989 Taiwan sample, the hazard ratio (HR) for maternal mortality associated with having an eldest son was 0.979 (95% CI 0.863 to 1.111). In Taiwan, daughters may have been more beneficial than sons in reducing mortality in recent years.
Conclusion The authors offer several explanations for these findings, including possible benefits associated with emotional and interpersonal forms of support provided by daughters and negative impacts of conflicts arising between parents and resident daughters-in-law.
Previous research shows that socio-economic status (SES) identity, also referred to as perceived or subjective social status, is shaped by objective measures of status, socio-cultural influences and psychological attributes and predicts current and future wellbeing. Prior studies, however, have not examined whether older adults reassess their SES identity over time. In this study, we use two assessments of subjective social status measured six years apart in a sample of older Taiwanese adults to: (a) determine the degree to which respondents adjust their perceptions of social rank; and (b) identify the characteristics of individuals who are most likely to revise their assessments. We find that many older Taiwanese adults reassess their SES identity, but most respondents show small to moderate levels of change. Females, more highly educated respondents, and those who have a positive economic outlook tend to revise their subjective social status upward relative to their respective counterparts; those who become widowed during the period adjust their rankings downward compared with those who do not become widowed. These findings suggest that SES identity may be dynamic, highlighting the importance of collecting information on SES identity at multiple points in the lifecourse.
Polymorphisms of the apolipoprotein E gene (ApoE) have been associated with health and longevity. Numerous studies have linked ApoE to health outcomes including cardiovascular disease and mortality, but far fewer studies have examined the relationship of ApoE to other biological markers of health. This study investigates the relationship between ApoE and mortality, as well as ApoE and a set of biomarkers related to cardiovascular and immune function, in a population-based sample of Taiwanese adults ages 54+. ApoE ɛ2 carriers were less likely to have at-risk levels of high-density lipoprotein (HDL-C) and total cholesterol (total-C) than non-carriers (odds ratio [OR] 0.45, 95% confidence interval [CI] 0.25–0.83 and OR 0.45, 95% CI 0.29–0.71, respectively). ApoE ɛ4 carriers were less likely to have elevated levels of C-reactive protein (CRP) than non-carriers (OR 0.62, 95% CI 0.39–0.96). ApoE genotype was not, however, associated with mortality after 8 years of follow-up. Our findings confirm the association between ApoE ɛ2 and cholesterol levels, suggesting a potential protective effect of ApoE ɛ2 on blood lipids. They also contribute to reports on the relationship between ApoE ɛ4 carrier status and lower CRP levels.
We evaluated the association between two aspects of social relationships and six inflammatory markers in Taiwan and the U.S. These two countries share similar levels of current life expectancy, but exhibit important differences in social structure. The data comprised population based samples from Taiwan (aged 53+; n = 962) and the U.S. (aged 35–86; n = 990) collected between 2003 and 2009. Circulating levels of interleukin-6 (IL-6), C-reactive protein (CRP), fibrinogen, and soluble forms of intercellular adhesion molecule 1, E-selectin, and IL-6 receptor (sIL-6R) were measured in fasting blood samples. A social integration score was based on marital status, contact with family and friends, church attendance, and other social participation. A perceived social support index was based on questions regarding the availability of care and support from family and friends. Linear regression models tested the association between these two measures and each inflammatory marker controlling for sociodemographic characteristics, obesity, medication use, and baseline health status. After adjusting for potential confounders, social integration had a significant but weak inverse association with CRP in Taiwan. Perceived social support was significant in two of 12 models, and the coefficient was positive (i.e., higher support was associated with higher CRP and sIL-6R in the U.S.). We found no evidence that the coefficients for social relationship measures varied by sex or age. Our results yielded limited evidence of a weak association between two dimensions of social relationships and six inflammatory markers in Taiwan and the U.S. Given that the literature suggests a strong link between social relationships and mortality, and that inflammation plays an important role in the leading causes of death, we had expected to find consistent and moderately strong associations between social relationships and inflammatory markers. The small effect sizes and lack of robustness across markers were surprising.
Objectives: To compare the effects of relaxation practice and other exercise on a multisystem measure of physiologic dysregulation in a national sample of older Taiwanese. Design: The study was a cross-sectional survey. Settings/location: The study was conducted in Taiwan. Subjects: A population-based sample of 1036 adults aged 53 and older completed an in-home interview and inhospital physical examination. The final model is based on 934 respondents with complete data. Outcome measures: The outcome measures were overall dysregulation, based on 26 biomarkers, and subscores for cardiovascular/metabolic risk factors and inflammatory markers. Results: After adjustment for age and sex, overall dysregulation is 0.35 of a standard deviation (SD) lower for practitioners of relaxation techniques compared with nonpractitioners. The effect of exercise is smaller: 0.19 SD difference between those who exercise regularly and those who do not exercise. Similar effects of relaxation practice and regular exercise were found on inflammation, but smaller effects for cardiovascular/metabolic risk factors. In the presence of controls for sociodemographic characteristics, medication use, and a wide range of self-reported and interviewer-assessed health indicators, the effect of relaxation practice is attenuated but remains sizable (-0.19 of a SD for overall dysregulation); regular exercise has a comparable effect (-0.16 of a SD). The effects are similar for the inflammation subscore, but not significant for cardiovascular/metabolic risk factors after adjusting for health status. Conclusions: The physiologic benefits of relaxation practice that have been demonstrated in small experimental studies are also evident in the general population of older Taiwanese who practice these techniques in everyday life. Relaxation practice is associated with lower levels of physiologic dysregulation, particularly with respect to inflammation. Among this sample of older adults, the effect appears to be at least as large as that for exercise. Older people with limited ability to engage in vigorous exercise may especially welcome such information.
Using the Los Angeles Family and Neighborhood Survey (L.A.FANS-2; n = 1610), we explore the link between Mexican immigrant acculturation, diet, exercise and obesity. We distinguish Mexican immigrants and 2nd generation Mexicans from 3rd+ generation whites, blacks and Mexicans. First, we examine variation in social and linguistic measures by race/ethnicity, duration of residence and immigrant generation. Second, we consider the association between acculturation, diet and exercise. Third, we evaluate the degree to which acculturation, diet, exercise, and socioeconomic status explain the association between race/ethnicity, immigrant exposure to the US (duration since immigration/generation), and adult obesity. Among immigrants, we find a clear relationship between acculturation measures, exposure to the US, and obesity-related behaviors (diet and exercise). However, the acculturation measures do not clearly account for the link between adult obesity, immigrant duration and generation, and race/ethnicity.
Objective. We investigate socioeconomic disparities in adolescent obesity in Mexico. Three questions are addressed. First, what is the social patterning of obesity among Mexican adolescents? Second, what are the separate and joint associations of maternal and paternal education with adolescent obesity net of household wealth? Third, are there differences in socioeconomic status (SES) gradients among Mexican boys and girls, rural residents and non-rural residents? Methods. Using data from the Mexican National Health Survey 2000 we examined the slope and direction of the association between SES and adolescent obesity. We also estimated models for sub-populations to examine differences in the social gradients in obesity by sex and non-rural residence. Results. We find that household economic status (asset ownership and housing quality) is positively associated with adolescent obesity. High paternal education is related to lower obesity risk, whereas the association between maternal education and obesity is positive, but not always significant. Conclusion. The household wealth components of SES appear to predispose Mexican adolescents to higher obesity risk. The effects of parental education are more complex. These findings have important policy implications in Mexico and the United States.
Objective: This study examines and compares respondent, interviewer, and physician ratings of overall health. Method: Data are from the 2006 Social Environment and Biomarkers of Aging Study, a nationally representative survey of older adults in Taiwan. Ordered probit models are used to examine factors associated with self- and external assessments of health and discordant health ratings. Results: Our results suggest similarities and differences in factors influencing health ratings across evaluators but a high level of interevaluator disagreement in ratings. Discrepancies in ratings between physicians and both respondents and interviewers are associated with the greater weight given to functional limitations and psychological well-being in interviewer and respondent ratings and to the importance of clinical measures or risk factors of illness and mortality in physician assessments. Discussion: Interviewer and physician assessments may be complementary to self-assessed health measures. The importance and implications of these findings for future research are discussed.
Despite a myriad of studies examining the relationship between socioeconomic status and health outcomes, few have assessed the extent to which biological markers of chronic disease account for social disparities in health. Studies that have examined this issue have generally been based on surveys in wealthy countries that include a small set of clinical markers of cardiovascular disease. The availability of recent data from nationally representative surveys of older adults in Costa Rica and Taiwan that collected a rich set of biomarkers comparable to those in a recent US survey permits us to explore these associations across diverse populations. Similar regression models were estimated on three data sets – the Social Environment and Biomarkers of Aging Study in Taiwan, the Costa Rican Study on Longevity and Healthy Aging, and the Health and Retirement Study in the USA – in order to assess (1) the strength of the associations between educational attainment and a broad range of biomarkers; and (2) the extent to which these biomarkers account for the relationships between education and two measures of health status (self-rated health, functional limitations) in older populations. The estimates suggest non-systematic and weak associations between education and high risk biomarker values in Taiwan and Costa Rica, in contrast to generally negative and significant associations in the US, especially among women. The results also reveal negligible or modest contributions of the biomarkers to educational disparities in the health outcomes. The findings are generally consistent with previous research suggesting stronger associations between socioeconomic status and health in wealthy countries than in middle-income countries and may reflect higher levels of social stratification in the US. With access to an increasing number of longitudinal biosocial surveys, researchers may be better able to distinguish true variations in the relationship between socioeconomic status and health across different settings from methodological differences.
The purpose of this paper is twofold: 1) to assess the link between migrant networks and becoming overweight or obese and 2) to explore the pathways by which migrant networks may contribute to the increasing overweight and obese population of children in Mexico. Using two waves of the Mexican Family Life Survey (MxFLS), we find that children and adolescents (ages 3 to 15) living in households with migrant networks are at an increased risk of becoming overweight or obese over the period of observation, relative to their peers with no migrant networks. Sedentary behavior and household-level measures of economic wellbeing explain some of the association between networks and changes in weight status, but the role of extended networks remains significant. Community-level characteristics related to migration do not account for any of the observed relationship between household-level networks and becoming overweight or obese.
This study assesses whether socioeconomic and demographic differences in reported mobility limitations are attributable to differential perceptions of mobility difficulty that result in the differential use of response categories.
Data come from the Social Environment and Biomarkers of Aging Study and its parent study, the Taiwan Longitudinal Study of Aging. Ordered probit models with person-specific cut-points are used to test whether, after controlling for underlying mobility using objective performance measures, cut-points for reporting mobility limitations vary across groups defined by demographic and socioeconomic characteristics.
Age is the only characteristic that is consistently associated with the location of the cut-points for reporting mobility difficulty: At the same level of underlying mobility difficulty, older adults are more likely than younger adults are to report difficulty with all tasks except short walks. Other variables showed differences but only for one specific activity, for example, urban residents are more likely to report difficulty running than are rural residents with the same underlying level of mobility function.
For most mobility activities, there are no systematic differences in the perception of difficulty by individual characteristics. Thus, for older Taiwanese adults, differences in mobility limitations associated with socioeconomic status are more likely to reflect underlying differences in function than differences in how these groups report the same capacity. The usual loss of mobility with age, however, reflects both a decrease in capacity and a lowering of the threshold for reporting difficulty.
Identifying how biological parameters change with age can provide insights into the physiological determinants of disease and, ultimately, death. Most prior studies of age-related change in biomarkers are based on cross-sectional data, small or selective samples, or a limited number of biomarkers. We use data from a nationally representative longitudinal sample of 639 Taiwanese aged 54 and older in 2000 to assess changes over a six-year period in a wide range of biomarkers. Markers that increased most with age were glycoslyated hemoglobin, interleukin-6, and norepinephrine. Markers that decreased most with age were diastolic blood pressure and creatinine clearance. For example, glycoslyated hemoglobin increased by 8% to 13%, depending on sex and age at baseline, over this six-year period. Several standard clinical risk factors exhibited little evidence of age-related change. Further research is needed to determine whether the observed variation between individuals in biomarker changes represents differences in underlying physiological function that are predictive of future health and survival.
Over the course of the 20th century, Mexico-U.S. migration has emerged as an important facet of both countries, with far reaching economic and social impacts. The health of Mexican immigrants in the U.S. has been well studied, but relatively less is known about the health of returned migrants to Mexico. The objectives of this paper are twofold. Relying on health data pertaining to two stages of the life course, early life health (pre-migration) and adult health (post-migration) from the Mexican Migration Project gathered between 2007 and 2009, we aim to assess disparities in adult health status between male returned migrants and male non-migrants in Mexico, accounting for their potentially different early life health profiles. While we find evidence that returned migrants had more favorable early life health, the results for adult health are more complex. Returned migrants have a higher prevalence of heart disease, emotional/psychiatric disorders, obesity, and smoking than non-migrants but no differences are found in self-rated health, diabetes, or hypertension.
Short and long sleep duration and sleep quality are associated with health including all-cause mortality, cardiovascular disease, diabetes, and obesity. Inflammation may play a role in mediating these associations.
We examined associations between inflammation and self-reported sleep characteristics in 1020 respondents of the 2000 and 2006 Social Environment and Biomarkers of Aging Study, a nationally representative survey of Taiwanese adults ages 53 and over. Regression models were used to estimate cross-sectional relationships between inflammation (interleukin-6, C-reactive protein, fibrinogen, e-selectin, soluble intercellular adhesion molecule-1, albumin, and white blood cell count) and a modified Pittsburgh Sleep Quality Index, index subcomponents, and self-reported sleep duration. Change in inflammatory markers between 2000 and 2006 was also used to predict long or short sleep duration in 2006.
Inflammation was not related to the overall index of sleep quality. However, longer sleep (>8 hr) was associated with higher levels of inflammation. These associations remained after adjustment for waist circumference, self-reported health decline, diabetes, arthritis/rheumatism, heart disease, and depressive symptoms. Increases in inflammation between 2000 and 2006 were associated with long but not short sleep duration in 2006 for several markers.
Long sleep duration may be a marker of underlying inflammatory illness in older populations. Future studies should explore whether inflammation explains observed relationships between long sleep and mortality.
Large numbers of foreign-born residents in the United States mean that many people receive at least part of their education abroad. Despite this fact, our understanding of nativity differences in the success of adults and their children is based on research that does not empirically consider variation in the benefits to schooling depending on where it is received. We use data from the Los Angeles Family and Neighborhood Survey (L.A. FANS) to examine: (a) whether the socioeconomic and cognitive returns to education depend on whether it is received in the U.S. or abroad; and (b) whether schooling location partially accounts for nativity differences in these returns. We find that the returns to schooling are generally largest for adults who receive at least some of their highest level of education in the U.S. The beneficial effects of U.S. schooling are more pronounced at higher levels of educational attainment. Schooling location accounts for a sizeable fraction of the lower socioeconomic and cognitive returns of the foreign-born, relative to natives; some meaningful differences remain, however. In addition, the higher cognitive skills of the children of foreign-born adults remain unexplained. Although we cannot distinguish among the possible pathways underlying these associations (e.g., school quality, transferability of credentials, the timing of immigration) our findings suggest the importance of considering factors related to schooling location as predictors of socioeconomic and cognitive success in the United States.
Background: We compare the genotype distribution for the serotonin transporter polymorphism (5‐HTTLPR) in a sample of older Taiwanese adults with samples of various racial and ethnic groups collected in other studies. We also explore interactions among sex, stressors, and 5‐HTTLPR genotype on depressive symptoms in our sample. Methods: Using a nationally representative sample of 984 Taiwanese aged 53 and older, we model depressive symptoms as a function of 5‐HTTLPR genotype and two classes of stressors: lifetime trauma and recent major life events. We test two‐ and three‐way interactions among stressors, 5‐HTTLPR, and sex. >Results: This sample exhibits higher frequency of S/S and lower frequency of L/L genotype than Western samples, but the distribution is comparable to those in East Asian populations. Nearly 9% carry an allele (XL) that has rarely been reported in the literature. Although the gene–environment (G×E) interaction with recent major life events is not significant, our results suggest that trauma has a worse effect on depressive symptoms for those with S/S or S/L genotype than for those who do not carry the S allele (P<0.05). We find no evidence that this G×E interaction varies by sex. Conclusions: Previous studies of this G×E interaction have been inconclusive, perhaps because interactions between genotype and stressful events are more prominent under extreme stressors. Our findings underscore the need to move beyond a bi‐allelic parameterization of the 5‐HTTLPR polymorphism and raise questions about why East Asian populations exhibit low rates of depression despite a high frequency of the S allele.
In a now well-publicised series of events during 2002 and 2003, the Women’s Health Initiative (WHI) and other randomised controlled trials (RCTs) designed to examine the links between postmenopausal hormone therapy (HT) and the prevention of chronic disease were terminated prematurely. The estrogen plus progestin arm of the WHI was terminated when a global health index indicated overall harm and a significantly higher breast cancer risk for the treatment group, and the estrogen arm was stopped because of an increased risk of stroke in the absence of evidence of cardioprotection.
Socioeconomic status is generally associated with better health, but recent evidence suggests that this ‘social gradient’ in health is far from universal. This study examines whether social gradients in smoking and obesity in Mexico – a country in the midst of rapid socioeconomic change – conform to or diverge from results for richer countries. Using a nationally representative sample of 39,129 Mexican adults, we calculate the odds of smoking and of being obese by educational attainment and by household wealth. We conclude that socioeconomic determinants of smoking and obesity in Mexico are complex, with some flat gradients and some strong positive or negative gradients. Higher social status (education and assets) is associated with more smoking and less obesity for urban women. Higher status rural women also smoke more, but obesity for these women has a non-linear relationship to education. For urban men, higher asset levels (but not education) are associated with obesity, whereas education is protective of smoking. Higher status rural men with more assets are more likely to smoke and be obese. As household wealth, education and urbanisation continue to increase in Mexico, these patterns suggest potential targets for public health intervention now and in the future.
Greater educational attainment is consistently associated with lower mortality and better health, a pattern known as the social gradient. However, recent research suggests that Mexican-origin adults in the US have weak or flat gradients, in contrast to steep gradients for non-Hispanic whites. In this study we evaluate one hypothesis for this finding: Is the relative weakness of education gradients in health behaviors observed among Mexican-origin adults in the US due to weak gradients in the sending population? We test this “imported gradients” hypothesis with data from two nationally-representative datasets: the US National Health Interview Survey (NHIS) and the Mexican National Health Survey (ENSA 2000). We compare education gradients in smoking and obesity for recently-arrived Mexican immigrants in the US to the corresponding gradients in high-migration regions of Mexico. Results partially support the imported gradients hypothesis and have implications for health education and promotion programs targeted to immigrant populations to reduce racial and ethnic disparities in health in the US.
Although the United States had one of the world’s highest life expectancies during the first half of the 20th century, this survival advantage gradually eroded during the ensuing decades. Of particular concern in the context of this volume is the recent stagnation in mortality improvement among middle-aged and older U.S. women relative to both U.S. men and to women in other wealthy nations (Meslé and Vallin, 2006; Vaupel, 2003). These mortality patterns suggest an appealing but as yet unexplored explanation: the use of postmenopausal hormone therapy (HT) among women in the United States. There is considerable evidence that, at least prior to 2002, estrogen-type hormones had been widely prescribed to U.S. women after the cessation of menses not only for relief of unpleasant symptoms associated with menopause but also increasingly for presumed protection against cardiovascular disease and bone loss.1 National estimates suggest a steady increase in HT use since the early 1980s, with a prevalence of about 38 to 40 percent among women ages 50 to 74 in 1995. Data on numbers of prescriptions for all forms of HT reveal a continued increase from 1995 to 2001, with the annual number of prescriptions peaking at 92 million in 2000 (Hersh, Stefanick, and Stafford, 2004).